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Whether CBD can help with a depressive disorder is a contentious issue. There are thousands of people shouting as loudly as they can about the apparent benefits of CBD oil for a number of conditions. The science is undetermined, however. That is not to write off CBD as a potential treatment for depressive disorders, but rather to add a note of caution against the hype and hyperbole that surround this modern “wonder drug.”
The charms of the snake oil salesperson have long been warned against. People have been trying to sell useless products for the treatment of common maladies for ages. The medical benefits of CBD is still being established in medical literature right now. So far, it is looking much better than many already existent drugs.
Depressive disorders are very common. The World Health Organization estimates that at least 300 million people “of all ages” suffer from depression. It is the biggest cause of disability worldwide and is one of the biggest factors in the development of disease worldwide. The social and economic costs of depression are hard to estimate, but it is thought to be in the hundreds of billions of dollars and over 1 million lives are lost to suicide each year.
Awareness is increasing and the treatments available are improving. There have been no major breakthroughs in terms of medicines for depressive disorders since the 1980’s, and many of the strongest 1st generation antidepressants and antipsychotics like lithium are still in use. The problem with this is that these medications can have a high cost. The patient may or may not commit suicide, or they can continue to work and have a relatively good life, but after some time they may have to discontinue the treatment, suffer withdrawal symptoms, and deal with the potentially life-long consequences of these powerful drugs.
This is the reason that as soon as a potential antidepressant drug that appears to have very few side effects becomes available, everyone gets excited. Needless to say, the hype surrounding CBD is enormous. There are dozens of websites with millions of readers talking about CBD, selling it, trying new formulas and treatments. The difficulty is that it is sometimes impossible to wade through the commercially motivated nonsense to find the genuine accounts and scientific evidence.
Exactly what causes depression is a matter of some debate. To understand a depressed brain, it can help to understand a bit about how the brain works. In the brain are close to 100 billion neurons. These are cells in the nervous system, and each has on average 10,000 connections with other neurons. Already you can imagine the complexity of the brain. You can imagine how hard it is to understand.
Each neuron communicates with its neighbours through electrical impulses, which travel along the long arms between them, which connect via synapses. These are the gaps between two neurons “arms” that a signal passes across. The signal passes across this gap by releasing neurotransmitters at one end and absorbing them on the other. If a signal gets to a synapse but does not release enough neurotransmitters, the signal is not passed along. This is very simply how brains communicate. The threshold of a synapse needs to be passed in order for the signal to propagate.
In depressed brains, these thresholds are changed. Some thoughts and feelings (which are incredibly complex sets of signals and thresholds) are made easier and others are much harder. One theory holds that the levels of neurotransmitters floating around some of the synapses changes when someone is depressed, so signals pass more easily or with more difficulty. When depressed brains are scanned in an MRI scanner, they are characteristically less active in some areas than in the brains of healthy people.
This makes sense: when you are depressed, you think differently to how you would normally think. When the thresholds are higher than usual, less signals will pass through. There appear to be “modes” of thinking that a person can engage in, and the brain can switch between them quite quickly, as is the case with bipolar disorder.
To add to this idea, when a signal is repeatedly passed along a neuron’s axon (the arm), the axon responds by adding more protein called myelin to the outside of the axon, which increases the speed with which signals pass. The more you think something, the better you get at thinking it. This is because of each time you think it, the myelin sheath around the axons that make up that thought pathway get thicker.
The brain’s incredible complexity, to some extent, explains the reason for there being different types of depressive disorders and mental conditions. Injury or infection can damage the brain and result in any type of depressive disorder. Some depressive disorders seem to seem to be caused by genetic risk factors being triggered by environmental factors. Common conditions include postpartum depression, seasonal affective disorder, and bipolar disorder. None are well understood.
Clinical depression is a broad term that covers all depressive disorders that have been diagnosed. To get a diagnosis, you need a qualified psychiatrist or doctor to make an assessment of your symptoms, family history, drug or alcohol use, medical history, and other factors that might contribute to your condition. Getting a diagnosis is the first step on the path to feeling better, so if you are feeling depressed, please talk to your doctor about how to get the right help.
Major Depressive Disorder
According to the American Psychiatric Association, up to 1 third of women will experience at least one major depressive episode in their lives. Currently, about 7% of the adult population are suffering from depression, or have done so in the last 12 months. Women are more likely to suffer from major depressive disorder but are less likely to kill themselves as a result, largely down to them using less lethal methods of suicide.
Major depressive disorder is the most common form of diagnosed depression. It is much more than the sadness and anxiety everyone feels from time to time. Depression is an often unbearable feeling of sadness, mixed with regret and fear or anxiety, that has no immediately identifiable cause.
Traumatic events or illness might trigger depression, but it is better thought of as a condition that is activated by certain events rather than the events causing the depression. This is because the underlying network of neurons is configured in a way that will result in depression in the right conditions.
It is common for people to feel grief, regret, or sadness after someone dies or a life changing event takes place but if it lasts more than a couple of weeks, you should talk to a doctor.
Symptoms of Depression Include
If you think you have some or any of the above symptoms and think you might have depression, please talk to your doctor.
These symptoms might be depression but they could have even more serious causes, for example nutrient deficiency, brain tumours, or thyroid problems. It is worth investigating.
For a clinical diagnosis, these symptoms must have lasted more than 2 weeks.
Standard Drugs for Depressive Disorder
The most commonly prescribed drugs for a depressive disorder are selective serotonin reuptake inhibitors, SSRIs. These work by stopping serotonin, a neurotransmitter, from being taken up by the synapse. The drug, say for example fluoxetine (Prozac), binds to receptors in the synapses and stops the reabsorption of serotonin. This increases the amount of serotonin in the synaptic gap, so the next signal that comes along the axon does not need to be as strong to make it over the gap because the extra serotonin reduces the threshold of signal transfer.
For some reason (nobody really understands why), most people find their mood improves with small doses of SSRIs. It seems like when a person is depressed, their thresholds in certain parts of the brain are heightened; adding SSRIs takes them back to a normal level and the patient feels better.
The problem with SSRIs is they often do not work, especially in the long term. Big studies have found that SSRIs are useful tools and when used appropriately, they make a huge difference to people’s lives. They do not seem to work in the long term, however. After a few months or years, the body can become tolerant to the drug and it stops working. Or the toxicity of the drug becomes too much for the body to cope with and it starts getting damaged.
In rare cases, people have psychotic episodes, commit suicide, or hurt themselves or others. It is not recommended that people under the age of 25 take many SSRIs because they actually increase the risk of suicide instead of reducing it. Some have even linked many of the school shootings in the United States to people on SSRIs or having recently stopped taking them. In the 1980’s, these drugs were seen as “wonder drugs”, and were widely prescribed for many mental illnesses. Now doctors and patients are more cautious as the safety record has been established and the drugs have been found to be often ineffective and sometimes extremely dangerous.
Even if SSRIs do not cause psychotic depression (it is rare), many people suffer from side effects. Some people experience digestive problems, weight gain or loss, dizziness, blurred vision, insomnia, pains, lowered libido, anxiety, agitation, erectile dysfunction, or loss of sexual performance. Other side effects can be much more serious. When the levels of serotonin in the brain get too high, it can be very dangerous.
One of the momentous achievements of the 20th century was the realization that talking about problems helps them get better. Of course, people always knew this, but there had never been an industry devoted to it. It started with Freud (who got nearly everything wrong) and has tumbled through the years, each generation adding more or less inaccurate and dangerous theories to the pile.
All along, the idea that talking through problems could somehow help that person find other ways of thinking about them have evolved.
Now psychologists have tools like MRI scans and CAT scans, they can tell more or less what is chemically happening in the brain of people with depression. This has led to the realization that talk therapies do in fact work–a reasonable amount of the time. Some people do not respond well to therapies like cognitive behavioural therapy, CBT, and need other methods. Most people do, however, and the idea that a person can find different ways of viewing their mental processes is at once ancient and very new. It has worked for a lot of people.
How can CBD Help?
People have been using cannabis to treat depression for as long as people have known about the effects of cannabis and felt depressed. Cannabidiol, CBD, is one of the chemicals in the cannabis plant and it has more recently been isolated and used in isolation to try get some of the benefits of cannabis without the high that delta-9 tetrahydrocannabinol, THC, can create. Cannabis might help with your depression, but if you are too stoned to work or do anything that requires complex thought, it is not much good. This is a great appeal of CBD.
The safety record of CBD has been explored and established to a level that many people will find sufficient. There have been dozens of small and medium scale scientific experiments with CBD, and they all find that the majority of people have no side effects from CBD, and those that do only experience mild dry mouth, occasional dizziness, diarrhoea, and fatigue. These symptoms disappear with further use or discontinuation of the treatment.
CBD is a very tolerable drug when compared to many other, more commonly used drugs. Long term data is essentially impossible to obtain at this time, so it is unknown how tolerable and safe the drugs are over an extended period.
The scientific evidence for CBD working for a depressive disorder is sparse. There are hundreds of anecdotal accounts of people successfully treating their depression with CBD, but the problem with anecdotal data is that it is impossible to compare with other experiences and control for outside factors. This is why clinical trials exist. Unfortunately, for the most of the last 100 years, cannabis and everything in it has been illegal–CBD included.
It remains illegal in much of the world regardless of the fact that it is a demonstrably safe drug with some fascinating and incredibly useful applications. This has made studying it very difficult. The result of this prohibition is that the science is nowhere near where it should be. The patient who wants a different way of dealing with their depressive disorder has been short changed; there is little evidence to go on.
The key system of neurotransmitters and receptors is called the endocannabinoid system. This is what cannabinoids act on to produce their effects. It is a complex, ancient, and vast system that extends all the way through the body, from the brain to the gut and the skin. Adding CBD to this system seems to change the way that cannabinoids interact with the receptors.
The two primary receptors are known as CB1 and CB2. THC and other cannabinoids bind directly to this and change how the neuron transmits signals. CBD is a little more subtle than this, however, it has a broader effect on how the receptors work.
There is a receptor that is commonly associated with depressive disorders called the 5-HT1A. It is a serotonin receptor. CBD appeared to interact more with this receptor than with the CB1 or CB2 receptors in depressed animals. Of course, applying what happens in an animal brain to a more complex one like a human’s brain is always difficult, but it does indicate the possible pathway for CBD’s antidepressant and anxiolytic effects in humans.
Depressed brains show different levels of endocannabinoid system activation. The hope is that cannabinoids can be used to restore balance to this system and then to the rest of the brain.
If this is possible, and it is a long way from being proven, cannabinoids and CBD will present a much safer and tolerable antidepressant option than many of the drugs available today.
There is a legalization movement spreading across the Western world, opening up cannabis to being studied more extensively for the effects to be properly understood. There are over 100 cannabinoids in cannabis and the combination of each seems to have a different effect, so the potential for very specific treatments is tantalizing.
Currently, nearly half of patients do not get full symptom withdrawal with current antidepressants. One quarter do not respond in a positive way. CBD, when it is better understood, presents the chance of having an easily produced, environmentally friendly, tolerable, relatively safe, and effective antidepressant.
Will it Work?
The jury is out for CBD and depressive disorder. There is not enough evidence to make a reliable decision. It is for the reader to make their own mind up. However, if CBD is legal in the country you live in, discussing it with your doctor will help you decide whether it is a treatment worth investigating. The risks of trying CBD for depression are relatively low, so with the careful guidance of a health professional you should be able to ascertain whether it works for you or not.
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